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Sunday 2 June 2013

THE PSYCHOLOGIST NEWS RE: DSM-5 - JUNE 2013 - Never far from controversy, the publication’s imminent arrival was overshadowed by a double-whammy of criticism from NIMH + the Division of Clinical Psychology (BPS)



As this month’s issue of The Psychologist
was headed to the printers, the American
Psychiatric Association were just days
away from publishing the eagerly
anticipated fifth edition of their
diagnostic code, the DSM-5. Never far
from controversy, the publication’s
imminent arrival was overshadowed by
a double-whammy of criticism – from the
director of the National Institute of
Mental Health (NIMH), the world’s
largest funder of mental health research,
and from the Society’s own Division of
Clinical Psychology (DCP).

Writing on his official blog, NIMH
Director Thomas Insel lamented the fact
that diagnostic categories in psychiatry
continue to be based on symptom
clusters, not on underlying biological
causes. ‘Patients with mental disorders
deserve better,’ he said, adding that his
organisation ‘ will be re-orienting its
research away from DSM categories.’ He
explained that for the last 18 months the
NIMH has been running a project called
Research Domain Criteria, which aims to
‘transform diagnosis by incorporating
genetics, imaging, cognitive science,
and other levels of information to lay
the foundation for a new classification

Headed by clinical psychologist
Bruce Cuthbert, the motivation for the
decade-long Research Domain Criteria
project is the frequent finding that
biomarkers for mental illness do not
match psychiatric diagnostic categories
that are based on patient symptoms. For
instance, an NIH-funded study published
earlier this year reported that the same
four genetic variations were associated
with five different psychiatric diagnoses
– autism, ADHD, depression, bipolar
disorder and schizophrenia (see April

Commentators were divided as to the
significance of Insel’s intervention.
Vaughan Bell of the Institute of
Psychiatry called it a ‘potentially seismic
move’. Hank Campbell, founder of the
Science 2.0 website, said the NIMH had
delivered a ‘kill shot to DSM-5’.
However, others were left wondering
what all the fuss was about. It is well-
documented that the original aim of
DSM-5 was to replace the old category-
based diagnostic system with a new
dimensional format based on underlying
biological risk factors, but the project
was abandoned for lack of adequate data.
In a press statement, DSM-5 chair David
Kupfer said the promise of biological
markers for mental disorders had been
anticipated since the 70s, but that we’re
still waiting. Meantime, he said DSM-5
‘represents the strongest system
currently available for classifying

Professor Francesca Happe, Director
of the MRC Social, Genetic and
Developmental Psychiatry Centre at the
Institute of Psychiatry and a member of
the neurodevelopmental disorders work
group for DSM-5, appeared to back
Kupfer’s view when she told us: ‘At the
beginning of the DSM-5 process, they
asked everyone to consider whether
neurobiological information, including
genetics and anything you can think of
on the biological side, could be used to
aid diagnosis in any of these conditions,
and the resounding answer was no,
or at least “not yet”.’

Meanwhile, the DCP issued
a statement attacking DSM-5 from
a different direction, for being too
biologically based and for minimising
‘psychosocial factors in people’s
distress’. The Division’s statement
(tinyurl.com/dcpdsm5) calls for a
‘paradigm shift’ in the diagnosis of
mental health problems, for an approach
‘that is multi-factorial, contextualises
distress and behaviour, and
acknowledges the complexity of the
interactions involved in all human
experience.’ It follows a similar
statement published by the British
Psychological Society last year.

However, challenging the DCP
statement in The Observer, Sir Simon
Wesseley, Professor of Psychological
Medicine at the Institute of Psychiatry,
wrote that ‘Psychiatry is the study of the
brain and the mind. Psychiatrists look at
the whole person, and indeed beyond
the person to their family, and to
society.’ He concluded that DSM ‘isn’t
the system of classification that we use
over here in any case. In practice, most
UK mental health professionals will
barely notice much difference... most of
those in the business of helping those
with mental disorders will be less
concerned with what is in and what is
out than with the reality of underfunded
and overstretched services. The idea that
we are part of a conspiracy to medicalise
normality will seem frankly laughable as
we struggle to protect services for those
whose disorders are all too evident
under any classification system.’


The Society’s Division of Educational
and Child Psychology is holding a one-day
event on 28 June: The Medicalisation of
Childhood: Time for a Paradigm Shift.
See www.bps.org.uk/decpjune28
Also, Simon Wesseley is running a
conference on DSM-5 at the Institute of
Psychiatry in London on 4 and 5 June:
(tinyurl.com/cgt56xr). Speakers include
DSM-5 Chair Dr David Kupfer, and
Honorary BPS Fellow, Professor of
Clinical Psychology David Clark CBE

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